2012年8月31日 訊 /生物谷BIOON/ --運用兩種化療藥物治療乳腺癌的婦女患者可能會遇到比以往研究發(fā)現(xiàn)的更多的心臟問題如心臟衰竭等,，據(jù)Journal of the National Cancer Institute雜志上刊出的一則研究證實。
研究主要領導者流行病學家Erin Aiello Bowles表示：因為越來越多的患有乳腺癌的女性存活時間延長了,，乳腺癌逐漸成為一種慢性疾病,，所以這項研究具有重要意義。乳房癌是美國最常見的癌癥之一,，在2011年,，估計有232620例診斷患乳腺癌。通常情況下，化療會引起其他健康問題,。
Bowles女士和她的同事們估計，現(xiàn)實世界中蒽環(huán)類藥物和曲妥珠單抗的使用與患者出現(xiàn)心臟衰竭和心肌病相關(guān),。早期的臨床試驗表明,，女性使用蒽環(huán)類藥物或曲妥珠單抗等治療乳腺癌的藥物后心臟衰竭、心肌病等疾病的風險增加,。
12500名診斷出患有浸潤性乳腺癌的婦女的回顧性隊列研究發(fā)現(xiàn)相比不接受化療的乳腺癌女性,，單使用蒽環(huán)類藥物的婦女罹患心臟衰竭或心肌病的風險明顯較高，但一結(jié)論與先前的臨床試驗結(jié)果類似,。但單獨使用曲妥珠單抗的女性出現(xiàn)這些心臟問題的整體風險更大,。聯(lián)合使用使用蒽環(huán)類藥物和曲妥珠單抗的乳腺癌婦女出現(xiàn)心臟問題的風險高于前期研究報告所得出的結(jié)論。Bowles女士補充說化療可通過幾種機制引起心臟問題,。這些藥物是有毒的,，他們殺死癌細胞，有時甚至會殺死體內(nèi)其他細胞,，但這些藥物對患者來說仍然是重要的,，因為這些藥物能改善乳腺癌婦女的生存情況，但對于任何藥物,，我們都需要明確了解有關(guān)風險,。（生物谷：Bioon.com）
doi:10.1093/jnci/djs317
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Risk of Heart Failure in Breast cancer Patients After Anthracycline and trastuzumab treatment: A retrospective cohort Study
Erin J. Aiello Bowles, Robert Wellman, Heather Spencer Feigelson, Adedayo A. Onitilo, Andrew N. Freedman, Thomas Delate,et al
Background Clinical trials demonstrated that women treated for breast cancer with anthracycline or trastuzumab are at increased risk for heart failure and/or cardiomyopathy (HF/CM), but the generalizability of these findings is unknown. We estimated real-world adjuvant anthracycline and trastuzumab use and their associations with incident HF/CM.
Methods We conducted a population-based, retrospective cohort study of 12?500 women diagnosed with incident, invasive breast cancer from January 1, 1999 through December 31, 2007, at eight integrated Cancer Research Network health systems. Using administrative procedure and pharmacy codes, we identified anthracycline, trastuzumab, and other
chemotherapy use. We identified incident HF/CM following chemotherapy initiation and assessed risk of HF/CM with time-varying chemotherapy exposures vs no chemotherapy. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for age at diagnosis, stage, Cancer Research Network site, year of diagnosis, radiation therapy, and comorbidities.
Results Among 12500 women (mean age=60years, range=22–99years), 29.6% received anthracycline alone, 0.9% received trastuzumab alone, 3.5% received anthracycline plus trastuzumab, 19.5% received other chemotherapy, and 46.5% received no chemotherapy. Anthracycline and trastuzumab recipients were younger, with fewer comorbidities than recipients of other chemotherapy or none. Compared with no chemotherapy, the risk of HF/CM was higher in patients treated with anthracycline alone (adjusted HR=1.40, 95% CI=1.11 to 1.76), although the increased risk was similar to other chemotherapy (adjusted HR=1.49, 95% CI=1.25 to 1.77); the risk was highly increased in patients treated with trastuzumab alone (adjusted HR=4.12, 95% CI=2.30 to 7.42) or anthracycline plus trastuzumab (adjusted HR=7.19, 95% CI=5.00 to 10.35).
Conclusions Anthracycline and trastuzumab were primarily used in younger, healthier women and associated with increased HF/CM risk compared with no chemotherapy. This population-based observational study complements findings from clinical trials on cancer treatment safety.
